On the MoundTommy
John surgical procedure helps pitchers return to the game

By
MARK CONCANNON

March 2015

Brewers pitcher
Johnny Hallweg had the Tommy John surgery.

"Sooner or
later, the arm goes bad. It has to." That prescient observation,
made by Yankees Hall of Fame pitcher Whitey Ford a half century ago,
still holds true today. But modern medicine can delay that inevitable
outcome.

Ulnar collateral
ligament reconstruction, better known as Tommy John surgery, was first
performed in 1974 on major league pitcher Tommy John by legendary
sports surgeon Dr. Frank Jobe. In the procedure, the UCL is replaced
with a tendon from somewhere else in the body.

Milwaukee
Brewers team physician Dr. William Raasch estimates heís performed
that surgery about 100 times on baseball pitchers at all levels and on
other athletes whose sports put stress on the UCL, such as wrestlers
and gymnasts.

"Itís
basically the ACL (anterior cruciate ligament, a common knee injury)
of the elbow," Raasch says. "Itís when the amount of
stress is greater than the ligament can bear."

The most common
transplant source for replacing the ligament is a small tendon in the
forearm, but if a patient does not have that tendon (15 to 20 percent
of people do not), a hamstring tendon can be employed. Surgeons create
a tunnel in the bone where the torn ligament was attached. The old
ligament is replaced with the reconstructed ligament, which can be as
strong or stronger than the original.

"Itís not
a difficult procedure," says Raasch who explains the outpatient
operation usually lasts around 45 minutes. "But itís a
technical procedure. You have to know exactly where youíre putting
those tunnels because thereís very little margin for error."

The procedureís
success rate is high, 80 to 90 percent for major league pitchers, but
the success rate drops in the lower levels of pitching. "Some of
these kids who tear their ligament, that may be secondary to very poor
mechanics," Raasch says. "They go back and throw the same
way afterwards, so itís (the ligament reconstruction) is going to
fail."

But sometimes,
even great pitching mechanics cannot overcome unfortunate genetics.
"To be a major league pitcher, you have to push your body to the
limit of what it can do, and then you have to have the genetics that
will allow that body to recover each time and hold up," Raasch
says. "We run into individuals that have the talent to pitch but
their body doesnít have the durability and they break."

Ligaments can
fail on one catastrophic single pitch, or in most cases, wear down to
the breaking point over time. After the surgery, patients will spend a
month in a brace to protect the reconstruction. The next step (6 to 8
weeks post-op) is to regain the range of motion. At the four-month
mark, when the ligament has had time to grow into the bone, pitchers
can start throwing short distances from flat surfaces, building up to
longer distances before throwing off a mound after six months. The
rehab process is slowed down at the slightest sign of discomfort.

Typical recovery
time for a major league pitcher who performs at the gameís highest
level is 18 months. College and high school pitchers, who face less
daunting performance standards, may be ready to compete again sooner.

"If a high
school pitcher can throw 85 miles an hour, doesnít need perfect
control and just needs to throw hard, he can be successful,"
Raasch says. "It takes longer for the professionals since they
need to be perfect with their control."

Raasch diagnosed
the need for Tommy John surgery for Brewers pitcher Johnny Hellweg
last April. Renowned sports surgeon Dr. James Andrews performed the
operation, and Hellweg is targeting an early to mid-2015 season return
to action.

Raasch, a
professor of orthopedic surgery at the Medical College of Wisconsin
who performs countless procedures on athletes and non-athletes, says
every surgery is critical, but admits thereís a special aura in the
room when a professional athlete is on the operating table.

"Thereís
a little elevation in everyone, a higher expectation, but every single
procedure, we treat it the same," he says. You could say this
pitcher is a Cy Young Award winner, but this high school kid weíre
fixing could be a future Cy Young Award winner."